Investigator II

Elevance Health

Investigator II investigating healthcare fraud and conducting claim reviews across multiple health plans. Collaborating with law enforcement and assisting in policy development for preventive measures.

Posted 7/9/2026full-timeDenver • California, Colorado, Illinois, Minnesota, Tennessee, Washington, Wisconsin • 🇺🇸 United StatesMid-LevelSenior💰 $78,320 - $128,160 per yearWebsite

About the role

Key responsibilities & impact

Responsible for the identification, investigation and development of cases against perpetrators of healthcare fraud
Claim reviews for appropriate coding, data mining, entity review, law enforcement referral
Responsible for identifying and developing enterprise-wide specific healthcare investigations
Effectively establish rapport and on-going working relationship with law enforcement
May assist in training of internal and external entities

Requirements

What you’ll need

Requires a BA/BS and minimum of 3 years related experience
Fraud certification from CFE, AHFI, AAPC or coding certificates preferred
Knowledge of Plan policies and procedures in all facets of benefit programs management with heavy emphasis in negotiation preferred
Health insurance, law enforcement experience preferred

Benefits

Comp & perks

Health insurance
401k contribution
Paid Time Off
Incentive and recognition programs
Equity stock purchase

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Case DevelopmentData MiningCoding ReviewEntity ReviewLaw Enforcement Referral

Soft Skills

Rapport BuildingTraining Ability

Certifications

CFEAHFIAAPC